Original scientific paper
https://doi.org/10.3325/cmj.2014.55.399
Cerebrospinal fluid outflow along lumbar nerves and possible relevance for pain research: case report and review
Karl Bechter
; Department of Psychiatry and Psychotherapy II, Ulm University/ Bezirkskrankenhaus Guenzburg Guenzburg, Germany
Bernd Schmitz
; Department of Neuroradiology, Ulm University/Bezirkskrankenhaus Guenzburg, Guenzburg, Germany
Abstract
CSF outflow through the cribriform plate near the olfactory
nerves and the outflow along brain and spinal nerves
are together known as peripheral CSF outflow pathway
(PCOP). It is still not clear whether the PCOP has pathogenetic
relevance. Our previous clinical observations have indicated
that CSF may interact with nerves along the PCOP
and in this article we present our finding of CSF outflow
demonstrated by myelography in a single patient. We also
discuss unexplained experimental pain pathomechanisms
against the background of the PCOP hypothesis. We observed
that CSF flowed along lumbar nerves in distal direction
at a speed of about 10 cm per hour on its way through
the tissues, mainly muscles. Total CSF outflow volume at
the lumbar site was remarkable. CSF outflow at lumbar
nerves was also documented by neuroradiology. It is plausible
that CSF signaling serves for interaction with nerves
along the PCOP, which could explain previously unknown
pathomechanisms in pain generation. Experimental findings
of tactile pain hypersensitivity within lumbosacral
pain pathways could be explained by releasing of molecules,
microparticles, or exosomes into the CSF by mast
cells, which then move with CSF outflow along the PCOP
and interact with nerves, initiating even retrograde synaptic
stripping.
Keywords
Hrčak ID:
129946
URI
Publication date:
15.8.2014.
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